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Conditions that may contribute to the need for a hip replacement include bone cancer, osteoarthritis, rheumatoid arthritis, and bone deformity. The most common indication for a total hip replacement is osteoarthritis which may be primary or secondary.
The hip joint may be replaced with a variety of material, including metal, polyethylene, and ceramic. A joint prosthesis is identified as a total hip replacement if both the articular surfaces of the acetabulum and femur are replaced.
In USA , m ore than 120,000 total hip replacement are performed annually. A 3% prevalence of prosthetic loosening and a 1% prevalence of prosthetic infection.
Why is this procedure performed?
Why is this procedure performed?
Usually, treatment for hip problems begins with pain medication and physical therapy to control discomfort. If this fails, doctors may suggest a hip replacement. Because hip problems cause pain, decrease a person's mobility and range of motion, and affect social or daily activities, hip replacement presents an appealing option for people in reasonably good health.
COMPONENTS OF HIP ARTHOPLASTY:
1) Acetabulum: Polyethylene plastic (with or without metal backing) or lucent polyethylene plastic acetabular component may contain metal wire. Prosthesis fixation to bone may use cement, spikes, screws or may be cementless (bone ingrowth or press fit).
2)Femoral stem composed of metal, femoral head composed of metal or ceramic.
Fixation may use cement or may be cementless (bone ingrowth or press fit).
COMPLICATIONS:
Early complications include dislocation, improper placement, and cement extrusion, DVT, fractures.
Late complications include implant failure, osseous fracture, heterotopic ossification, loosening, infection, and aggressive granulomatosis (or particle disease), implant failure, heterotopic ossification, loosening of a prosthesis and multiple surgeries with long term bracing.
Absolute contraindications to total hip replacement include sepsis, a remote source of ongoing infection, muscular dysfunction and severe vascular disease. Relative contraindications include medical conditions that preclude safe anesthesia and the demands of surgery and rehabilitation.
How should I prepare for this procedure?
How should I prepare for this procedure?
Your complete medical history will be documented and an examination of the hip will take place before the procedure. The doctor performing the procedure may also request other tests to understand your joint's performance.
routine blood tests as in any major surgery
Bone density tests
magnetic resonance imaging (MRI)
specific checkups for chronic diseases
urinalysis
X-ray
Patients with ischemic heart disease, congestive heart failure, and chronic obstructive airway disease should be seen by a medical specialist or anesthetist.
The aim of total hip replacement is to resurface the deficient and damaged joint surfaces with a low-friction articulation.
Selection of regional or general anesthesia is made following preoperative discussion between the anesthetist, the patient and input from the surgical team. The operation should be performed in a laminar flow operating theatre with meticulous attention to detail to prevent contamination of the operation site.
The patient is recovered and usually observed for a 24-hour period in a high-dependency ward. Adequate hydration and analgesia are essential in this time of high physical stress.
Drains are usually removed within 24 hours, and the patient is encouraged to walk on the second postoperative day. At this early stage, the patient begins hip exercises. These are continued under the supervision of a physiotherapist until discharge. Continual improvement is generally observed, and discharge occurs in 5-7 days. Discharge is only recommended once wound healing is satisfactory patient able to walk with crutch support and no complications are present.
PHYSIOTHERAPY often continued at home for a period of time. The first outpatient review generally is in 2 weeks then 6 weeks and after 3 months.
Follow-up care: Follow-up depends on the surgeon, the patient, and the health care system. A typical example would be a surgical follow-up appointment at 6 weeks, 3 months, 6 months and then every year. This is modified for each patient according to age, degree of activity, and presence of complications.
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Personalized services
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Effective treatment and surgery
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Physiotherapy and Rehabilitation program
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